Stevens Johnson Syndrome (SJS)

Jean Farrell knew something was wrong. The Denver travel agent had left for work in the morning and noticed that her 11-month-old daughter, Julie, had a swollen eye. Julie, an epileptic, had been placed on phenobarbitol, a widely used anti-convulsant drug, about two weeks prior. Farrell asked her mother to watch Julie during the day. But when Farrell returned from work later that day, however, both of Julie’s eyes had swollen completely shut. The concerned mother quickly called Julie’s pediatrician who asked Jean to bring her into his office. As Jean and Julie were leaving, Farrell noticed small blisters on Julie’s lips, as well as red spots forming at various places on Julie’s skin. Julie was also running a high fever.

“The pediatrician looked at Julie and told me she had a viral exanthem,” Farrell said. “The doctor checked Julie’s ears and noticed that pus-filled blisters had formed on Julie’s ear drum. He thought it was unusual. He then changed the diagnosis to chicken pox with an ear infection. He told me to keep giving her the phenobarbitol and also prescribed an antibiotic for the ear infection.”

But this course of action did little Julie no good. “The next day,” Farrell continued, “Julie had developed large blisters on her lips, as well as inside her mouth and ears. Her eyes were still swollen shut, the red spots on her body had grown to the size of quarters and were ulcerating. She had so many blisters in her mouth that she couldn’t swallow.” Farrell, knowing that Julie had not had anything to drink for several hours, thought she might be dehydrated and took her to the emergency room. “The hospital staff told me that Julie had ‘a really bad case of the chicken pox.’ They placed her on an IV for her fluids and, when they learned Julie was epileptic and on phenobarbitol, added that into her IV treatment.”

Julie got steadily worse. “My baby’s face was unrecognizable. She looked like she had been deep-fried,” said an agitated Farrell, obviously upset at having to relive the horrific events. “Finally, an older, very experienced nurse boldly said to the doctor and me that Julie did not have the chicken pox, but Stevens Johnson Syndrome. She said she knew because she had seen other cases before. The doctor did not believe her and left the room. I was bewildered: “What is wrong with my little girl?”

A short while later, another doctor came into Julie’s room to find Jean Farrell sobbing hysterically. “He asked me what was wrong with my daughter and I told him that nobody seemed to know. Then, I mentioned that the nurse thought Julie had Johnson’s disease. The doctor looked at me and said, ‘Stevens Johnson Syndrome?’ I blurted out, ‘That’s it.’ He took one look at Julie and immediately removed the IV with the phenobarbitol. He then called the Burn Unit, an opthamologist, and an infectious disease specialist. Finally, somebody knew what was happening.”

While Jean was at last relieved to discover what her daughter’s problem was, the doctors involved were not. They told her, “Jean, this is not a good thing.” And Farrell would find out why in the next three weeks that Julie was in the hospital. “Julie’s lungs had to be constantly suctioned to remove fluid and mucous that kept accumulating there. Her skin and mouth continued to blister and ulcerate for weeks and she was completely wrapped in bandages. She was on morphine for the incredible pain. In order to work on her eyes, I had to hold my baby down on the bed while the doctors pried her blistered eyes open with glass rods. When they did this, the skin under her eyelids literally sloughed off. There was blood everywhere and Julie was in agony; this happened on her first birthday. A one year old child not knowing why this was happening to her.”

Despite several close calls, Julie survived her ordeal, but not without permanent damage. She is completely blind in one eye and has limited vision in the other. She must constantly wear sunglasses as her eyes are very light-sensitive. While her skin has mostly healed, she still has noticeable scars on her legs and back. She may have sustained kidney damage as well. Jean Farrell started the Stevens Johnson Syndrome Foundation to educate the public about the dangers of allergic drug reactions: “I don’t want anyone to go through what me and Julie did.”

What Is Stevens Johnson Syndrome?

Stevens Johnson Syndrome, or SJS, is an extreme allergic reaction, usually to a drug, but also to certain bacterial and viral infections. “We usually distinguish between three forms,” said Dr. Bernard Cohen, MD, of Johns Hopkins Hospital in Baltimore, “a milder form called Erythema Multiforme Minor, or EM, Stevens Johnson Syndrome, SJS, and TENS, or Toxic Epidermal Necrolysis Syndrome, the most severe form. With EM, which can be recurrent, there will be lesions on the distal extremities [lower legs and arms] and in the mouth; there is little mucous membrane involvement, however. With SJS, which is usually not recurrent, there are usually blistering ulcerations of the cornea, mouth, rectum, genitalia, skin, and urethra, usually accompanied by a high fever and generalized weakness. TENS involves the entire skin and mucous membrane; the skin literally sloughs off of the person’s body.”

While there are a number of infectious causes that can initiate an SJS reaction, the most common culprits are drugs. The drugs most implicated are anti-convulsants (like phenobarbitol), sulfonamides, or sulfa drugs, non-steroidal anti-inflammatory drugs (NSAIDS), including ibuprofen, barbiturates, and antibiotics such as amoxicillin and tetracycline. “We just lost a 17-year old boy in Kansas City to SJS apparently caused by tetracycline, ” Farrell said ruefully. “He was taking it for his acne. We also have a woman whose daughter went blind after taking ibuprofen. People need to realize that over-the counter-drugs can cause SJS too.”

Difficult to Diagnose

Dr. Cohen, a pediatric dermatologist and medical advisor to the SJS Foundation, explained, “Typically, the reaction begins within the first two weeks of taking the drug (if that is the true cause.) The eyes will get puffy, swollen, and gritty. There will usually also be cracking or small blisters on the lips and mouth. Usually the person has a fever and red patches on the skin. Most people think they have the flu.” Or the chicken pox as Jean and her daughter found out. “Chicken pox is the most common misdiagnosis, at least for children. It’s amazing how many doctors and nurses don’t know what SJS is,” she pointed out.

For Sherry Callejo, a secretary at the University of Hawaii, her doctor’s ignorance about SJS almost cost her her life. Callejo took a fourteen day course of a sulfa drug for a sinus infection. “About two days after I finished the treatment, my face and lips got tingly and splotchy. The next day my lips were darker, and two days later they were completely black and my mouth was full of sores. My face was bright red. My doctor, an internal specialist, did not know what was happening and he sent me to an infectious disease specialist who correctly diagnosed me with SJS. By then, all my mucous membranes were inflamed and blistering, but especially my mouth and genitalia. My torso and neck were covered in splotchy bruises.” Although Callejo sustained some corneal scarring, her vision was not affected. She continued, “I’ve seen pictures of people with much worse reactions than me. I consider myself very lucky.”

Standard Treatments

If and when SJS is diagnosed, the offending drug must be removed at once. It is common to prescribe steroids like prednisone to quell the overactive immune system, but both Dr. Cohen and Ms. Farrell stated that there is no conclusive evidence that steroid treatment halts an SJS reaction though Callejo definitely felt it helped her: “I felt much better after three days on the steroids.”

Since the skin is literally burning from the inside out, with extensive blistering and ulceration, standard burn treatments are common. Many SJS patients are referred to Burn Treatment Centers. “Care must be taken to prevent staph infections of the skin from taking hold,” Dr. Cohen said. “Intravenous fluids to prevent dehydration are a must,” he continued, “as the person is usually unable to eat or drink due to the mouth blisters.”

Both Farrell and Cohen admitted sadly that there really is nothing to halt an SJS reaction once it has begun. All that can be done for the unfortunate person affected by it is to deal with the secondary manifestations of the disease.

Long Term Damage

While the acute SJS reaction may be finished in less than a month, its effects can last a lifetime. For the 15-20 percent of SJS victims whose eyes have sustained damage, the Scleral Lens, developed by Dr. Perry Rosenthal of the Boston Foundation for Better Sight, offers considerable relief. “We have many clients of the Foundation using the scleral lens. It’s enabling Julie to see right now, ” said an elated Farrell.

“Usually we tell SJS survivors to use extra sunscreen and to stay out of the sun for awhile as they are more susceptible to skin cancer,” Farrell went on. “Patients’ immune systems are in overdrive and shock after an SJS episode so they usually end up with several allergies. We’ve had a few clients use alternative therapies to good effect. We have a girl whose nails fell off now using acupuncture and Chinese medicine; the nails are growing back.”

Dr. Cohen added that sometimes SJS victims sustain permanent lung and esophageal damage. Callejo, for example, has esophageal scarring and frequent coughing that she controls with a steroid inhaler.

More severe damage occurs sometimes in people who survive TENS. Often, they become heat sensitive and lose the ability to sweat–the skin damage can be that extensive.

Less severe aftereffects from SJS can linger for months. “It’s been 14 months since my episode and I still don’t have all of my energy back,” said a frustrated Callejo. “I feel like something in me is missing, almost spacey.”

Betty Ellen Ford, an 84 year-old Honolulu resident, concurred: “It’s been 18 months and my legs are still scarred. I still have flare-ups in my mouth making it difficult for me to eat sometimes.” Ford had an SJS reaction after being given a common drug for a respiratory infection.

A Rare Disorder?

Medical textbooks commonly state that SJS and TENS are extremely rare disorders. But Farrell strongly disagrees: “SJS is NOT as rare as we are led to believe. Since setting up the SJS Foundation and launching our website, we’ve been contacted by thousands of individuals. During the winter months, we were learning of 15 new cases a week, and that’s only through the Internet. How many affected people were out there without access to the Internet? After Julie’s episode, I was told by almost every doctor that SJS was so rare that I would never meet another person who had had it. Well, after the local news in Denver ran a story on Julie, I was contacted by several people whose children had been through it. That was the start of our support group. Just last week I was contacted by a man with HIV who had contracted SJS by taking the currently recommended “drug cocktail” for AIDS. We’ve been contacted by people as far away as China and South Africa. This disease is not rare–it’s on the rise.”

Many people thank God for Farrell’s organization. “When I got some strength back, I did a search on the net for SJS and found Jean’s foundation,” Callejo said fondly, “It and Jean were heaven sent. It felt so good to find others who could relate to what I was going through and I’ve benefited from the support group and on-line chat room the website supports.”

How does Farrell keep the Foundation and website going? Ironically, through a generous grant from United Airlines. Farrell did approach several drug companies about funding, but was curtly turned down. “I first approached the companies who manufactured the drugs that were the most implicated in SJS. I made it clear that we were not looking to blame anyone; we just wanted more knowledge about SJS and more research done so that it could be stopped.” Despite this cooperative approach, the response she got was, nevertheless, defensive. “This one company told me something like, ‘There are so many environmental issues surrounding SJS. How can you be sure it’s coming from our drug?’ I couldn’t believe this answer! I mean, let’s blame Mt. St. Helen’s for SJS! It is true that the package inserts for several drugs do mention SJS as a remote risk factor, but how many people know what SJS is? How would they know they were having a reaction that could possibly kill them?”

Natural Therapies for SJS

If there is a lack of information in allopathic medicine on SJS, there is an even greater lack in natural therapies. It’s important to realize that SJS is a modern disease and that it is not generally associated with herbs, supplements, or homeopathics. It is also imperative to point out here that someone with SJS needs to be in a hospital under acute care. Nevertheless, natural therapies can be employed to help with the rebuilding process.

Joan Scott-Lowe, a registered nurse and practicing homeopath in Alabama, feels that homeopathy could be a useful adjunct to standard treatment. “Allergies are dealt with in homeopathy by giving a homeopathic dose of the substance to build up resistance to it. In the case of SJS, since the person is hypersensitive to a drug, the drug would have to be prepared homeopathically at a dose no less than 15C or 24X to be sure that no gross substance remained. Theoretically, this could help.” “Theoretically” is the operative word here; no one has ever tried this approach. Lowe also added that standard homeopathic remedies for more serious burns such as Cantharis and Urtica urens could be administered under the direction of a trained practitioner.

Supplements of vitamins A, E, C, B complex, zinc, and essential fatty acids could be employed to rebuild the immune system and skin damage. Vitamin A is particularly crucial for the eyes and mucous membranes, and vitamin E is known for its anti-scarring properties. Farrell spoke of a few mothers of SJS-affected children who had placed a drop of vitamin E oil directly on their child’s scarred cornea, often to good effect. Farrell also reported that Julie’s frequent infections after her SJS episode disappeared once she began taking daily multivitamin/mineral and vitamin C supplements. Julie’s epilepsy was brought under control, without the use of anti-convulsants, through a ketogenic diet that restricted carbohydrates of all types.

Mouth lesions could be soothed by holding liquid aloe vera in the mouth, and by gently washing the mouth out with 1 oz of water with a few drops of tea tree oil added. Aloe could also be applied to the skin. Despite positive anecdotal stories, more research is needed here, however.

A Nightmare that Can End

SJS is definitely a nightmare, but there is hope. With adverse drug reactions being the 4th leading cause of death in North America, it behooves each person to think carefully before taking something. If a blood relative has had an allergic reaction to a drug in the past, even a mild one, consider yourself at risk and avoid the drug. “I was shocked to find out after my reaction that my father and brother both had developed skin rashes when they took sulfa drugs for short periods in their lives,” Callejo said. “If only I’d known.” It makes more sense, however, to seek drug-free alternatives for one’s ailments if and when they arise.

Nevertheless, knowledge is power and all those interviewed for this article felt that more education about drug reactions and SJS were needed. Farrell said forcefully, “It is so tragic. You’re warned not to give aspirin to children. How can you not tell people about a life-threatening reaction to a drug . . . any drug?”

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2000.

About Stephen Byrnes, ND, RNCP

Stephen Byrnes, BA, MA, DR(AM), was a nutritionist and naturopath who grew up in New York and attended Hunter College in New York City where he received his BA in Comparative Religion. After moving to Los Angeles, he completed his MA in Humanities at California State University at Dominguez Hills. He then received his Diploma in Homeobotanical Therapy from the Australasian College, USA, a state-licensed college in Lake Oswego, Oregon, and his Doctorate of Alternative Medicines from the Alternative Medicines Research Institute (AMRI), a licensed and registered educational institution in Gibraltar, European Union, affiliated with the Open International University of Complementary Medicines, Colombo, Sri Lanka. He later received his Graduate Diploma in Naturopathy from the Canadian Alternative Medicines Research Institute (CAMRI), Vancouver, British Columbia. CAMRI is licensed and registered with the Private Post-Secondary Education Commission of British Columbia.

Dr. Byrnes had over 100 articles and papers published in health magazines and professional journals around the world. He was an honorary board member of the Weston A. Price Foundation and an editorial board member of the Australian holistic magazine WellBeing. He also authored four books: Digestion Made Simple (Whitman Books; 2002); Diet & Heart Disease: It’s NOT What You Think (Whitman Books; 2001); Overcoming AIDS with Natural Medicine (Healing Light Ministries; 2001); and The Lazy Person's Whole Foods Cookbook (Healing Light Ministries; 2001).

Dr Byrnes died of a stroke in 2004 at the age of 42. During the final years of his life, he suffered extreme physical, emotional and financial stress, including threats from a stalker and having to defend himself in a frivolous lawsuit. He is greatly missed by his many friends and colleagues at the Weston A. Price Foundation.

Reader Interactions

Comments

Hey I’m Emma I’m 15 and I have been diagnosed with a mild case of this I’m admitted in children’s what do you think are so good natural remedies someone can bring me while I’m here I want to use as much stuff as I can to fight this

When I was 17, I was in a car accident. Upon release, I was given pain killers and sulfa drugs. About 4 days after being released, the palms of my hands and bottoms of my feet began to burn and itch. My mother an RN, took me back to the ER, where they gave me benadryl and sent me home. The next day, ulcers started popping up in my mouth, and genitals-once again, my mother took me to the ER, where they did the same as they did the day before. Third day, I began having seizures, and literally started praying to God to let me die. My mother was holding my hands, and gently ribbing my palms when the skin lifted from my fingers and sloghed off in what I can only desctibe as a thick sheet of skin.
Finalky, my mother took me to the children’s hospital ER, since I was still 17 and considered a child. She called a friend of hers who, looked at me from across the ER waiting room, and admitted me, knowing exactly what was wrong with me.
SJS was a horrific experience, and for years after the effect, i sufferred from the blow it had on my immune system. At 18 I was diagnosed with von Wildebrands Disease, which has added to the recovery process. I am now 34 now.

I had sjs when i was 10 years old in 2003. I was hospitalized for 3 weeks and sick for over a month. It was very difficult and iy mind was hazzy the entire time. I had a temp of 103 for 3 days to start with. I was first diagmosed with pnemonia and i was given medicine which we believe caused the sjs. I am now 21 and thank god i am healthy. I do get minor sicknesses like the common cold and flue and i have alergies but all tgat aside i am healthy. The only vanity lroblem is i have a part of my lip that came off while i had sjs and sonce my lip has tried to close the gap but i still have a little dent in my bottom lip that sheds skin spmetimes. Those being my only side affects i feel very furtunet.

I was told I had this disease 60 years ago when I was 7. I don’t remember much of those months, I only have what my mother told me. I was in bed for 3 months and the Doctor told my parents that I was not going to make it anyway, so I would be better off at home in the care of my family. I blistered everywhere, lost my hair, nails and lashes. 3 months after going through this disease, I was down to 30 pounds. I don’t remember being in pain. I do remember getting out of bed on Easter morning to attend Church, I could hardly walk and my dress was a size 3 toddler. I healed and got better and stronger each day. I missed 3 months of school. The doctor told my mother that because I had beat the disease, that I would have a strong immune system, and boy do I. I hardly ever get sick. My long term effects have been problems with my eyes and kidneys. when the eye lashes started growing back, some grew inward and constantly caused pain and had to be removed. Doctors tried to fix this by taking skin from the inside of my cheeks and lining the lids to prevent the lashes from growing inward. It was an experiment that only made things worst and left my eyes looking puffy with no lashes at all. I take care of the lashes myself now and could have then if only the doctors had not been so eager to use me as a guinea pig for their research benefits. My kidneys are still weak but I take care of that myself using home remedies. Other than the eye issues, and a low tolerance to light, I am very healthy. My vision is 20/25, so I am blessed to be able to see that well. At the age of 68, I take no medications, only vitamins and whole food supplements. One thing I did want to ask was about nightmares. I have very vivid dreams and often scream out during these dreams. I had read at one time that this is also a symptom of SJS. And my doctor called my disease “Acute Steven Johnson Bright Disease”.

Your story sounds just like my moms. She had this happen at age 10 and is 75 now. She mostly has issues with her eyes and had a similar surgery has yours and has no eyelashes. I know she can’t handle bright lights and spends a lot of time working on her eyelashes that still grow inside. Feel terrible for her and you

I took Sulfa meds for one of those “newlywed UTI’s” and had multiple trips to the doctors who misdiagnosed me with everything from Herpes to an old person’s lung disease. I was 21 at the time. I was told I had the rare form of this rare syndrome because besides mouth & private area covered in sores I sloughed skin internally (lungs, intestines, esophagus, etc). I was hazy, but I remember peeing, pooping, and throwing up blood! My new husband was worried out of his mind & was the one who ultimately keyed the doctors into SJS, having himself had the minor Erythema Multiforme EM version when he was a teen. I remember how crestfallen when they told me treatment was rest and witamins! Since then (about 15 yrs ago) I have noticed that I do dry out in all mucus membranes more quickly than I used to. I tend to get bronchitis whenever I get sick. I fight with gastrointestinal issues also. I have not been able to find out much about what happens after…like sloughing internally or externally creates scar tissue which covers/protects, but does not function the same. Are my bronchitis and gastro issues related to internal scarring?

I had SJS as an adult in 1998 – I don’t remember much of it, because I was on so many drugs and out of it from the fevers, but initially I was diagnosed with Scarlet Fever, because nobody could figure out what was wrong with me. I was very lucky and eventually recovered, but I still have a lot of problems with my lungs, due to so much scarring and I have had trouble with auto-immune illness like chronic urticaria. I have lost dental implants because of my body rejecting them. I also suffer from extreme fatigue, which I believe to be a result of having SJS. I think that, although you recover initially (if you are lucky), you never get 100% better.

I am keolebogile in south Africa I am also a victim of sjs I was diagnosed on February 2016..I had all the symptoms of sjs my mouth where full of blister I couldn’t eat or talk. .my eyes..skin full of blister…I get tears running through my eyes when I had to explain what I went through..How can we get sjssupport group and lay claims here in south Africa? please help

Hi my name is Sthembile from South Africa and I have also been a victim of Stevens-Johnson’s Syndrome just recently.I was diagnosed in February due to sulfa drugs that had been prescribed to me by a doctor because of my low immune system and I spent two weeks in hospital.I couldn’t walk, talk, eat and see properly. It was one of the most horrific experiences that I have ever been through. I am slowly recovering each day but till today I’m still traumatized. I had such beautiful skin but now everytime I look at my skin I just tear up because of the horrible scars that I’m left with. My confidence has gone down to level zero and I’m always self-conscious and insecure around people now. Please assist me as to what skin products I can now use to better the appearance of my skin and to bring back my complexion. Thank you in advance.

Hi I am grace and I’m 16 The summer of 2016 my skin broke out of blister when thought it was flee bites because my dads had flees and I have always reacted bad to big bites so my broke gave me antibiotics which made it worse So May of this year my skin broke out again I was given more antibiotics which lend to my whole hand breaking out I was sent to a dermatologist it was my first time ever going to one and I was scared My Doctor told me it was SJS we had never heard of it before and I was scared I couldn’t work because of the open sores and I was so emabarred to see my friends each break out leaves me with scars and it’s really hard to feel normal

I was misdiagnosed and given a medication that caused the Sjs and ten syndrome. I spent 22 days in the burn unit and was in a coma for 4 days. It’s been only 8 months since this happen and it’s horrible. I have constant nightmares, severe depression, ptsd, anxiety, joint and muscle pain ect… This is new to me and I am 42 years old. I never knew about this syndrome till now and I worked in the medical field for 10 years and never heard of this syndrome. It saddens me that no-one has ever talked about it and made it an important issue in which people would know about this. I am very weak still and always crying, 60 percent of my body burned from the inside out. Inhale horrible visible scars. I lost all confidence in myself. I worked all my life and always took care of myself. Now I just hide from the world .I live in Wisconsin’s and am in need of a support group. Please help thank you